What should you know about a small bald spot?

A smooth, round or oval patch without scaling can occur with alopecia areata, an immune-related condition that targets hair follicles. Scalp ringworm can cause hair loss along with itch, scale, broken hairs, tenderness, or swollen areas. Repeated tight hairstyles, extensions, or habits that pull the hair can also create a local patch. Rubbing, scratching, or inflammation may damage hairs near the surface.

Look at the skin as well as the missing hair. Redness, crusting, flakes, pain, pus, broken hairs, or a shiny change in the skin give a clinician useful clues. A patch can stay limited or become larger, and new areas may appear, so a clear photograph can help you compare changes over time.

Arrange a medical assessment if the patch is new, enlarging, recurring, or unexplained. The clinician may inspect the scalp and hair shafts closely, ask about recent illness, medicines, stress, hairstyles, and family history, and check other body sites. If infection is suspected, testing may be needed before treatment is chosen.

Until you are assessed, avoid tight braids, glued extensions, harsh chemical treatments, and picking at the area. Use gentle washing and do not share combs, brushes, hats, or pillowcases if the patch is scaly or itchy, because some scalp infections can spread. Do not apply steroid or antifungal products to the scalp without advice about the cause.

Seek prompt medical care for a bald patch with marked pain, warmth, swelling, pus, spreading redness, fever, or tender lumps in the neck. Arrange an earlier review if eyelashes or eyebrows are also thinning, several patches appear, the scalp becomes smooth and shiny, or hair loss follows a new medicine or significant illness. These features can point to infection, more extensive hair loss, or inflammation that needs timely treatment.

Ask: What changes on my scalp suggest the cause? Do I need a fungal test or another examination? Which treatments fit this type of hair loss, and what side effects should I watch for? Should I change my hairstyle or hair products? When should I return if the patch grows or new areas develop?